UNIVERSITY OF PITTSBURGH FORM INSTRUCTION GUIDE
FORM NUMBER: FORM 0048 PITT 1801
FORM TITLE: Parking Agreement
EFFECTIVE DATE: July 1997
PAGE (S): 2
ENTER THE FOLLOWING INFORMATION WHERE INDICATED:
(Shaded areas are for Parking Office use only.)
1. University parking lot abbreviation.
2. Parking Permit number, if applicable.
3. Key access card number, if applicable.
4. ID number.
5. Transaction Type: Check to indicate the purpose of the transaction (e.g. to initiate a
parking agreement, terminate a parking agreement).
6. Date the transaction is effective.
7. Date the Parking Agreement was received by the Parking Office (to be entered by the
8. Applicant's name: Last, First, MI (limit to 39 characters).
9. Applicant's campus telephone number.
10. Applicant's social security number.
11. Applicant's campus address, room number, and building (see SPI 9).
12. School/Responsibility Center.
13. Department name.
14. University account number if method of payment is an interdepartmental charge.
Enter the following information for all vehicles the applicant intends to park using the
University Parking Permit:
15. License plate number of vehicle.
16. State of vehicle registration.
17. Vehicle make.
18. Wait list lot/garage request.
For Payroll Deduction Only:
19. Social security number of applicant.
20. Payroll deduction code.
21. Check to indicate paycheck frequency (biweekly or monthly).
22. Dollar amount of payroll deduction.
23. Effective date of payroll deduction start.
24. Effective date of payroll deduction termination.
25. Signature of applicant and date.
26. Signature of Parking Representative and date.